Category: Statistics

Altern Ther Health Med. 2023 Jul 28:AT877. Online ahead of print.

ABSTRACT

OBJECTIVE: This research aims to investigate the effectiveness of 3D computer-assisted customized guided positioning of the lateral femoral tunnel compared to conventional methods for Anterior Cruciate Ligament (ACL) reconstruction surgery.

METHODS: A total of 80 patients with a complete ACL tear who underwent arthroscopic reconstruction with autologous tendon transplantation (semitendinosus-gracilis tendon) were included in this study. The patients were admitted to our hospital between March 2020 and January 2022 and were randomly divided into two groups: the conventional group (n = 40) and the personalized guide group (n = 40), based on the positioning method. The conventional group underwent ACL restoration using standard surgical techniques, while the personalized guide group opted for the more precise computer-assisted personalized guide method. The lateral femoral tunnel times were compared between both groups. Additionally, the International Knee Documentation Committee (IKDC) and Lysholm scores were assessed, and the lateral femoral location was evaluated using X-ray imaging at 2 weeks postoperatively.

RESULTS: After surgery, both groups showed a statistically significant increase (P < .05) in Lysholm and IKDC scores compared to their pre-surgery scores. However, the two groups had no evident difference (P > .05). X-ray evaluation at 2 weeks post-surgery revealed no significant difference between the two groups in NL/ML, AL/BL, α, and β angles (P > .05). The preparation time for the femoral tunnel was significantly shorter in the personalized guide group (6.18 ± 0.92 min) compared to the traditional group (15.94 ± 3.12 min) (P < .05).

CONCLUSIONS: The computer-assisted 3D personalized guide positioning method is more effective in locating the lateral femoral tunnel for ACL reconstruction of the knee and can substantially reduce the positioning time. This study provides valuable insights for clinicians when selecting surgical methods.

PMID:37499157

Altern Ther Health Med. 2023 Jul 28:AT8584. Online ahead of print.

ABSTRACT

OBJECTIVE: Wound healing is delayed because of swelling after upper limb fracture, and the traditional rehabilitation device used in physical therapy cannot flexibly adjust the fixation. This study aims to evaluate the effect of the designed elbow joint airbag protection device used in patients with upper arm fractures.

METHODS: This is a quasi-randomized controlled trial. From November 2022 to March 2023, 70 hospitalized patients with unilateral upper arm fractures were recruited from a general tertiary hospital in eastern China. The patients were divided into an experimental group and a control group according to the random number table at 1:1. Among them, 35 patients who received elbow joint airbag protection for post-traumatic limb swelling were assigned to the experimental group, and the other 35 patients were assigned to the control group. The degree of swelling regression, a score of resting pain, and patient comfort level was compared between the two groups.

RESULTS: The waiting time from swelling to allowing for surgery and pain score at rest were significantly lower in the experimental group than in the control group (P < .05 and P < .001 respectively). The comfort score of the experimental group was higher than that of the control group (P < .05), and these differences were statistically significant.

CONCLUSIONS: The elbow joint airbag protection can significantly reduce the waiting time for surgery, lessen the degree of swelling regression, reduce the pain in patients’ hands caused by swelling, and significantly improve the comfort level. Hence, it is worth promoting in the clinical practice of orthopedic nursing.

PMID:37499154

Altern Ther Health Med. 2023 Jul 28:AT8570. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to explore the predictive value of various indicators in the application of C-CHEWS (Cardiac-Children’s Hospital Early Warning Score) during the transition period of infants with left-to-right shunt congenital heart disease after surgery.

METHODS: A retrospective study was conducted on 229 infants who underwent surgery for left-to-right shunt congenital heart disease at a tertiary pediatric hospital in Anhui Province from January 2019 to March 2022. The infants’ status was evaluated using C-CHEWS scores within 1 hour of transfer from the ICU to the transitional ward. A cutoff score 6 was used, with scores ≤6 defining the control group and scores ≥7 defining the observation group. The predictive value of various indicators during this period was analyzed.

RESULTS: The 229 infant patients were divided into the control group (n = 154) and the observation group (n = 75). All infants received sufficient oxygen inhalation, and 210 infants underwent VIS (Vasoactive-inotropic Score) evaluation, with 137 in the control group and 73 in the observation group, showing a statistically significant difference between the two groups. All infants were discharged without recurrence of ICU admission within 48 hours. In the C-CHEWS evaluation, medical staff attention and parental concern were assigned 1 point, while the consciousness level received 0 points. The respiratory system scores ranged from 2 to 3 points without a statistically significant difference, whereas the cardiovascular system scores ranged from 0 to 3 points and showed a statistically significant difference. Among the 75 observation group patients, 43 were boys, accounting for 57.33%.

CONCLUSIONS: During the transition period after surgery for congenital heart disease in infants, monitoring the cardiovascular system, along with the effective application of VIS, through C-CHEWS scoring, can help detect warning signs. Focusing on managing cardiovascular function is crucial to reduce the risk of disease deterioration, promoting comfort, and aiding in the infants’ recovery.

PMID:37499152

Altern Ther Health Med. 2023 Jul 28:AT8209. Online ahead of print.

ABSTRACT

BACKGROUND: With social development, an aging population, and the increasing trend of obesity, type 2 diabetes (T2DM) has become one of the major problems affecting human health across the globe.

METHODS: Information on controlled trials was retrieved from four databases to obtain the effects of different doses of canagliflozin combined with metformin for treating T2DM. After a rigorous evaluation of the quality of the literature, data analysis was performed using RevMan 5.3 software.

RESULTS: We included 8 studies in this meta-analysis. The least square (LS) means of HbA1c and FPG in the test group were statistically lower than the control group. Our analysis revealed that the adverse reactions were not significantly different between the experimental and control groups (OR: 1.03; 95% Cl: 0.94, 1.12; P = .555). Also, we found that the urinary tract infection of the experimental group was not statistically different from the control group (OR: 0.94; 95% Cl: 0.71, 1.24; P = .648). Moreover, we identified that the blood pressure and blood lipids of the experimental group did not statistically differ from the control group.

CONCLUSION: The meta-analysis demonstrates that high doses of canagliflozin combined with metformin may be potentially effective in patients with T2DM, as evidenced by LS means of HbA1c and FPG, and the above conclusions need to be verified by more high-quality studies.

PMID:37499149

Urol Pract. 2023 Jul 3:101097UPJ0000000000000429. doi: 10.1097/UPJ.0000000000000429. Online ahead of print.

ABSTRACT

INTRODUCTION: Citing high costs, limited diagnostic benefit, and ionizing radiation-associated risk from CT urogram, in 2020 the American Urological Association revised its guidelines from recommending CT urogram for all patients with microscopic hematuria to a deintensified risk-stratified approach, including the deimplementation of low-value CT urogram (ie, not recommending CT urogram for patients with low- to intermediate-risk microscopic hematuria). Adherence to revised guidelines and reasons for continued low-value CT urogram are unknown.

METHODS: With the overarching objective of improving guideline implementation, we used a mixed-method convergent explanatory design with electronic health record data for a retrospective cohort at a single academic tertiary medical center in the southeastern United States and semistructured interviews with urology and nonurology providers to describe determinants of low-value CT urogram following guideline revision.

RESULTS: Of 391 patients with microscopic hematuria, 198 (51%) had a low-value CT urogram (136 [69%] pre-guideline revision, 62 [31%] postrevision). The odds of ordering a low-value CT urogram were lower after guideline revisions, but the change was not statistically significant (OR: 0.44, P = .08); odds were 1.89 higher (P = .06) among nonurology providers than urology providers, but the difference was not statistically significant. Provider interviews suggested low-value CT urogram related to nonurology providers’ limited awareness of revised guidelines, the role of clinical judgment in microscopic hematuria evaluation, and professional and patient influences.

CONCLUSIONS: Our findings suggest low-value CT urogram deimplementation may be improved with guidelines and implementation support directed at both urology and nonurology providers and algorithms to support guideline-concordant microscopic hematuria evaluation approaches. Future studies should test these strategies.

PMID:37499130 | DOI:10.1097/UPJ.0000000000000429

Br J Surg. 2023 Jul 27:znad231. doi: 10.1093/bjs/znad231. Online ahead of print.

ABSTRACT

BACKGROUND: Colorectal cancer is the third most common cancer, with nearly 2 million cases worldwide and just under 1 million deaths in 2020. Several trials have demonstrated that aspirin has the potential to reduce the incidence and/or recurrence of colorectal cancer; however, the optimal aspirin dose is unclear.

METHODS: Relevant studies were identified by searching MEDLINE, Embase and the Cochrane Library from database inception to 2 February 2022. Data from RCTs in which the incidence of colorectal cancer in patients without active colorectal cancer assigned to aspirin versus control were included. Two investigators independently identified studies and abstracted data. Study quality was assessed using Cochrane Collaboration risk-of-bias 2 tool. The study was performed according to PRISMA guidelines. Aspirin dose was stratified into low (50-163 mg/day), mid (164-325 mg/day), and high (500-1200 mg/day).

RESULTS: Thirteen articles representing 11 RCTs (92 550 participants) were included, with studies assessing aspirin as primary prophylaxis in general or high-risk populations, and as secondary prophylaxis for metachronous colorectal cancer. There was a statistically significant reduction in colorectal cancer incidence in the high-dose aspirin group compared with the group that received no aspirin or placebo (OR 0.69, 95 per cent credible interval 0.50 to 0.96; surface under the cumulative ranking 0.82). There was no statistically significant difference between mid- and low-dose aspirin versus no aspirin/placebo.

CONCLUSION: In this network meta-analysis of RCTs, high-dose aspirin was associated with a reduction in colorectal cancer incidence. However, this was based on a limited number of trials. This study did not show a statistically significant risk reduction in colorectal cancer incidence with mid- or low-dose aspirin.

PMID:37499126 | DOI:10.1093/bjs/znad231

AIDS Care. 2023 Jul 27:1-7. doi: 10.1080/09540121.2023.2240066. Online ahead of print.

ABSTRACT

Understanding motivations and resilience-associated factors that help people newly diagnosed with HIV link to care is critical in the context of universal test and treat. We analyzed 30 in-depth interviews (IDI) among adults aged 18 and older in western Kenya diagnosed with HIV during home-based counseling and testing and who had linked to HIV care. A directed content analysis was performed, categorizing IDI quotations into a table based on linkage stages for organization and then developing and applying codes from self-determination theory and the concept of resilience. Autonomous motivations, including internalized concerns for one’s health and/or to provide care for family, were salient facilitators of accessing care. Controlled forms of motivation, such as fear or external pressure, were less salient. Social support was an important resilience-associated factor fostering linkage. HIV testing and counseling programs which incorporate motivational interviewing that emphasizes motivations related to one’s health or family combined with a social support/navigator approach, may promote timely linkage to care.

PMID:37499119 | DOI:10.1080/09540121.2023.2240066

J Sports Sci. 2023 Jul 27:1-15. doi: 10.1080/02640414.2023.2241782. Online ahead of print.

ABSTRACT

Direct and moderation effects of swimming competence using an integrated model of self-determination theory (SDT) and theory of planned behaviour (TPB) were examined in two large-scale studies among young children. Specifically, we examined whether swimming competence had direct and moderation effects on social psychological variables of perceived need support, autonomous motivation, TPB social cognition constructs, and intention. In Study 1, using a cross-sectional survey of 4959 primary school children, swimming competence formed significant positive relationships with all model variables (β =.061 to.330, p < .05) except intention (β = -.009, p > .05), and its moderation effect on model parameters were small in size or not statistically significant. In Study 2, using a pre-post-test quasi-experiment among 1,609 primary school children, improvement of swimming competence was associated with change-scores in all model variables (β =.046 to.230, p < .05) except subjective norm (β =.049, p > .05). Swimming competence did not significantly moderate the parameter estimates of the integrated model (p > .05) at the change-score level. Findings indicate that swimming competence is associated with higher autonomous motivation; TPB social cognitions of attitude, subjective norm, and perceived behavioural control; and intention. However, swimming competence did not moderate the parameter estimates of the integrated model.

PMID:37499112 | DOI:10.1080/02640414.2023.2241782

Swiss Med Wkly. 2023 Jul 27;153:40103. doi: 10.57187/smw.2023.40103.

ABSTRACT

OBJECTIVES: Active surveillance for low-risk prostate cancer closely monitors patients conservatively instead of the pursuit of active treatment to reduce overtreatment of insignificant disease. Since 2009, active surveillance has been recommended as the primary management option in the European Association of Urology guidelines for low-risk disease. The present study aimed to investigate the use and uptake of active surveillance over 10 years in our certified prostate cancer centre (University Hospital of Zurich) compared with those derived from the cancer registry of the canton of Zurich, Switzerland.

MATERIALS AND METHODS: We retrospectively identified all men diagnosed with low-risk prostate cancer at our institution and from the cancer registry of the canton of Zurich from 2009 to 2018. The primary treatment of each patient was recorded. Descriptive statistics were used to analyze the use of different treatments in our centre. The results were compared with those derived from the cancer registry.

RESULTS: A total of 3393 men with low-risk prostate cancer were included in this study (University Hospital of Zurich: n = 262; cancer registry: n = 3131). In the University Hospital of Zurich and cancer registry cohorts, 146 (55.7%) and 502 (16%) men underwent active surveillance, respectively. The proportions of local treatment [115 (43.9%) vs 2220 (71%)] and androgen deprivation therapy [0 (0%) vs 43 (1.4%)] were distinctly lower in the University Hospital of Zurich cohort than in the cancer registry cohort. The uptake of active surveillance over the years was high in the University Hospital of Zurich cohort (35.4% in 2009 and 88.2% in 2018) but only marginal in the cancer registry cohort (12.2% in 2009 and 16.2% in 2018).

CONCLUSION: Despite clear guideline recommendations, active surveillance for low-risk prostate cancer is still widely underused. Our analysis showed that access to a certified interdisciplinary tumour board significantly increases the use of active surveillance.

PMID:37499067 | DOI:10.57187/smw.2023.40103

Oral Dis. 2023 Jul 27. doi: 10.1111/odi.14682. Online ahead of print.

ABSTRACT

BACKGROUND: Observational studies have found associations between smoking, alcohol, radiation, body mass index (BMI), periodontitis, and the hazard of benign salivary gland neoplasms (BSGNs). Nevertheless, the etiology of BSGNs remains unclear. This study aims to assess the causal association between these modifiable factors and the BSGNs.

METHODS: Genetic instruments associated with exposures at the genome-wide significance level were selected from corresponding genome-wide association studies. The summary statistics for BSGNs were obtained from the FinnGen consortium (2445 cases and 340,054 controls). The inverse variance-weighted method was used as the primary analysis, and several sensitivity analyses were performed to test the reliability.

RESULTS: Genetically predicted higher lifetime smoking index (odds ratio [OR] = 2.10, p = 0.012) and BMI (OR = 1.58, p = 2.29 × 10^-5 ) were associated with elevated risk of BSGNs, whereas other exposures do not. Sensitivity analyses showed consistency. The causal effect of the lifetime smoking index became more significant after adjusting for BMI (OR = 2.89, p = 0.005) and alcohol consumption (OR = 2.49, p = 0.002). A slight negative association emerged for alcohol consumption with adjustment for cigarettes per day (OR = 0.53, p = 0.034) but disappeared when adjusting for cigarettes per day and BMI.

CONCLUSION: This study supports the independent causal role of lifetime smoking index and BMI in BSGNs risk.

PMID:37499050 | DOI:10.1111/odi.14682